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Isoproterenol (Isuprel) is a nonselective beta adrenergic agonist structurally very similar to epinephrine which I use most commonly in the electrophysiology (EP) lab to induce tachyarrhythmias for the electrophysiologist to map out and ablate. Unfortunately, this medication is also is a classic example of the price gouging imposed by pharmaceutical companies. Production rights for isoproterenol transitioned several times in the last few years, and with that, the price escalated from ~$50 to well over $1,000 per vial. And no, we can’t blame “drug shortages” this time.

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Another classic indication for using isoproterenol is in heart transplant patients. These patients often times require a direct adrenergic agonist to modulate their heart rate as their donor hearts are denervated. In my practice in both the ICU and OR settings, I use alternatives like dobutamine and epinephrine to achieve many of the same adrenergic/hemodynamic goals as isoproterenol for much cheaper. Understanding the mixture of adrenergic receptor agonism conferred by these medications either as sole agents or in combination is a pivotal part of hemodynamic management in acute care medicine.

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